Center for Aging & Community boosts nursing home quality

The Indiana State Department of Health and the Center for Aging & Community at the University of Indianapolis are collaborating on a statewide initiative to improve the quality of long-term care in nursing homes. The Regional Healthcare Quality Improvement Collaborative Project is designed to assist long-term care facilities in developing quality assurance and performance improvement programs, which soon will be required for all nursing homes as they have been for other types of healthcare providers. The intent is to form regional collaborative groups with representatives from healthcare facilities, provider associations, consumer advocacy groups, and community organizations. The collaborative partners will work together to conduct needs assessments, design regional quality improvement plans, and provide education and resources to nursing homes in their areas.

CAC accepted applications for funding, with up to $30,000 available per collaborative over 18 months for up to seven regional projects. The Center provides each lead organization with guidance, training, and technical support regarding the QAPI projects developed through the initiative. The Regional Healthcare Quality Improvement Collaborative Project is a sister to the Indiana State Department of Health’s recently launched Advanced Education Project, which provides advanced education opportunities throughout the state on wound care, healthcare-associated infections, Alzheimer’s and dementia care, and process improvement.
Many Indiana nursing homes have participated in previous regional collaborative projects developed by ISDH and CAC, including the Indiana Pressure Ulcer Initiative that began in 2007 and the Indiana Healthcare Associated Infection Initiative that began in 2010.

UIndy, IU experts collaborate on nursing home employee program

The behavior of dementia patients can pose challenges for nursing home staff, especially if workers don’t realize their own actions may be part of the problem. Now a special six-week training course developed by University of Indianapolis and Indiana University experts has taught nearly 40 nurses and other employees from 19 central Indiana long-term care facilities how to avoid creating stressful situations and therefore rely less on medication to help patients manage their behavior. “It’s not just memory that is affected with dementia; we need to recognize that their perception of the world is altered,” says Ellen Miller, executive director of UIndy’s Center for Aging & Community. “There are all sorts of things we can do to prevent challenging behaviors before they start. This makes life better for both the resident and the staff.”

People with dementia have limited ability to understand and respond to conversation, TV programming, and other everyday stimuli, says Anne Thomas, dean of UIndy’s School of Nursing and one of the developers and instructors for the training sessions. Some patients are troubled by seeing themselves in mirrors, she says. With others, facing simple choices about clothing or food can fuel frustrations and lead to aggressive behavior. “They live literally in the moment, and there is no new learning,” Thomas says. “If you give choices, they get overstimulated.” The training program at Fountain Square Center, a community health facility on Shelby Street, included interactive one-on-one exercises with actors posing as dementia patients exhibiting aggressive and nonaggressive negative behavior, both verbal and physical. The sessions were videotaped for analysis and discussion, giving participants useful tips and concepts they can put into practice where they work and share with colleagues and even their patients’ families. “It’s a very experiential kind of training,” Thomas says. “The idea is to empower the staff to go back and treat these behaviors without medication.”

In addition to Thomas and Miller, the team behind the program includes Monica Tegeler, a physician and assistant professor in IU’s Department of Geriatrics; and Amy Pemberton, a registered nurse at Kindred Transitional Care and Rehabilitation in Greenwood. All are involved in OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care), a four-year effort funded by the federal Centers for Medicare and Medicaid Services. Now in its third year, the initiative led by IU and the Regenstrief Institute is working with 19 central Indiana nursing facilities to improve care, reduce hospitalizations, and increase access to palliative care for long-term nursing facility residents. Specially trained nurses such as Pemberton are stationed in each participating facility to promote best practices and better communication among staff members. Thomas co-chairs the OPTIMISTIC advisory board, Miller serves on the lead project team, and the Center for Aging & Community staff coordinates all training for participating nurses and nursing home personnel.